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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416239
Report Date: 10/17/2025
Date Signed: 10/17/2025 03:51:50 PM

Document Has Been Signed on 10/17/2025 03:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SAFARI KID - EVERGREEN FOWLERFACILITY NUMBER:
434416239
ADMINISTRATOR/
DIRECTOR:		PALLAVI SATPATHYFACILITY TYPE:
850
ADDRESS:3122 FOWLER ROADTELEPHONE:
(408) 600-6031
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 60TOTAL ENROLLED CHILDREN: 36CENSUS: 0DATE:
10/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Jayshree SitkaraTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 10/17/2025, Licensing Program Analyst (LPA), Farida Raja, met with Licensee Representative, Jaishree Chitkara for an unannounced Annual/Random inspection. There were no children present during today's inspection. Licensee Representative informed LPA that it is a staff learning day and therefore no children are in attendance today. The facility is licensed to serve 48 preschool children, ages 2-6 years in Redwood Room, Sequoia 2 Room and Valley Oak Room and 12 toddler option children in the Sequoia 1 Room. LPA observed all required posted materials near the facility entrance. Days and hours of operation are Monday through Friday, 8:00 AM to 6:00 pm. Facility has one waiver on file for shared outdoor area between the toddler and preschool children. Licensee Representative submitted a copy of the Designation for Facility Responsibility (LIC 308) and updated Emergency Disaster Plan for Child Care Centers (LIC 610) during today's inspection. Licensee Representative to submit a copy of the Toddler Agreement, Needs and Services Plan, Personnel Report (LIC 500) and children's roster to LPA via email by 10/18/2025.

LPA and Licensee Representative toured the indoor and outdoor areas of the facility during today's inspection. Classrooms, children's restrooms, staff restroom and kitchen were inspected. Facility has central heating/cooling for comfort of children. Licensee Representative states that there are no weapons or firearms on the premises. There is a working telephone at the facility. Disinfectants and cleaning products are stored in high cabinets, inaccessible to the children in care. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed solid waste containers with tight-fitting lids in the rooms. LPA observed appropriate diaper changing table in the Sequoia 1 Room and a trash can with tight fitting cover for the disposal of diapers. Napping cots are appropriate. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAFARI KID - EVERGREEN FOWLER
FACILITY NUMBER: 434416239
VISIT DATE: 10/17/2025
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LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. Log shows that the last Fire Drill was conducted on 08/19/2025 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles and drinking water fountains outdoors. Water lead testing was completed by the facility on 10/03/2023 and no Action Level Exceedances were reported.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA provided Licensee Representative with the Water Lead Report from the California State Water Resources Control Board during today's inspection. Licensee Representative emailed a copy of the LIC 9275, LIC 9276 and facility sketch indicating the water outlets tested to LPA during today's inspection.

Facility provides meals and snacks to the children in care. Facility uses disposable utensils. Menu was observed to be posted in the facility kitchen. Licensee Representative stated that parents have the option to provide meals and snacks as well. Food and beverages were stored safely to prevent contamination and spoilage. Food preparation areas were observed to be sanitary. LPA advised Licensee that refrigerator used to store children's items needs to be clean and maintained in good condition. All food and beverages that require refrigeration are stored in covered containers.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient rubber flooring as resilient material to absorb falls. Areas around and under high climbing equipment and slides were cushioned with resilient material. Shaded rest area is provided by pergola's and trees. There were no bodies of water observed. LPA advised Licensee Representative to check children's toys and equipment and remove or make inaccessible toys that are not in good repair. All wading pools and water tables need to be immediately emptied after each use. LPA also advised Licensee to have children in the toddler component access the outdoor area through the front entrance to prevent commingling with children in the preschool program.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAFARI KID - EVERGREEN FOWLER
FACILITY NUMBER: 434416239
VISIT DATE: 10/17/2025
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Children sign in and out procedures and logs were reviewed. Children's roster was reviewed. LPA reviewed eight children’s files during today's inspection. Each child's file reviewed contained the required forms. Licensee Representative stated that they are not caring for any children under 2 years of age at this time.

LPA discussed the safe sleep regulations with Licensee Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. LPA provided Licensee Representative with a copy of PIN 20-24-CCP and sample 15 minute sleep check log.

Three staff files were reviewed. All teachers and staff maintain valid background clearances. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification. Licensee Representative understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required immunization's against pertussis, measles and influenza or statement declining the influenza immunization. LPA observed required Mandated Reporter Training on file for all staff.

Licensee Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. Licensee Representative stated that facility does handle medications but currently has no children in care who require medications or Incidental Medical Services (IMS). Any medications at the facility are stored in a locked cabinet in the Director's office and are inaccessible to children in care. Isolation of sick child was discussed, and Licensee Representative explained that sick children will be isolated in the director's office and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SAFARI KID - EVERGREEN FOWLER
FACILITY NUMBER: 434416239
VISIT DATE: 10/17/2025
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Facility does not provide transportation to children. Licensee Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

As a result of today's inspection, there were no deficiencies cited. Exit interview conducted and report was reviewed with Licensee Representative, Jaishree Chitkara.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Farida Raja
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
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